Provider Demographics
NPI:1306160270
Name:PODIATRY FOOT AND ANKLE CARE PLLC
Entity type:Organization
Organization Name:PODIATRY FOOT AND ANKLE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-544-5425
Mailing Address - Street 1:5415 PARK ST N
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1087
Mailing Address - Country:US
Mailing Address - Phone:727-544-5425
Mailing Address - Fax:727-544-5440
Practice Address - Street 1:5415 PARK ST N
Practice Address - Street 2:SUITE C
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1087
Practice Address - Country:US
Practice Address - Phone:727-544-5425
Practice Address - Fax:727-544-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3257213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1306160270OtherGROUP NPI
FL615430600OtherOFFICE OF WORKERS COMPENSATION
FLP00835981OtherRR MEDICARE INDIVIDUAL
FL3482826OtherMAIL HANDLERS BENEFIT PLAN
FL65944OtherBC/BS
FLCY302AOtherMEDICARE PTAN
FL615430600OtherDEPT. OF LABOR
FL6413570001OtherDME SUPPLIER ID
FL1360219OtherAMERIGROUP
FLDQ3766OtherRR MEDICARE GROUP
FL1360219OtherAMERIGROUP
FLCY302AOtherMEDICARE PTAN
FLV11282Medicare UPIN